Perioperative mannitol intensive use may avoid the early complication of cerebral venous sinus stenting

Bai, Chaobo; Chen, Jian; Wu, Xinxin; Ding, Yuchuan; Ji, Xunming; Wang, Mengqi

doi:10.21037/atm-20-3021

Cited by 3 publications

(8 citation statements)

References 22 publications

(34 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…7,35,36 Moreover, our previous study demonstrated that hemorrhage usually occurred in the brain region contralateral to the side of the stent due to transient pressure differences between the two sides that leads to the contralateral perforating vein being pulled and injured. 15 In the present study, 4 patients suffered bleeding events in the control subgroup. The bleeding events included a hemorrhage in right parietal lobe, subdural hemorrhages in the right pare, and intracranial hemorrhage in the preoperative infarcted lesion.…”

Section: Headache and Intracranial Hemorrhage Post-stentingmentioning

confidence: 42%

“…This can result in a friable venous wall that is prone to damage and hemorrhage from endovascular maneuvers 7,35,36 . Moreover, our previous study demonstrated that hemorrhage usually occurred in the brain region contralateral to the side of the stent due to transient pressure differences between the two sides that leads to the contralateral perforating vein being pulled and injured 15 …”

Section: Discussionmentioning

confidence: 99%

“…which largely deteriorate clinical outcomes. 6,7,[9][10][11]15 In addition, the inflammatory process may cause restenosis of CVSS resulting in poor outcomes. 16,17 We have noticed that even though the obstruction of venous reflow was corrected, and the mean pressure gradient (MPG) across the stenotic segment was diminished or even disappeared after stenting, patients had even higher serum levels of inflammatory biomarkers and increased brain edema in the initial days post-stenting compared to their baseline, which may explain why patients with CVSS had even more aggravated symptoms in the early period poststenting.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Intensive mannitol slow infusion post‐stenting may attenuate stenting‐related early adverse effects in patients with cerebral venous sinus stenosis

et al. 2023

Self Cite

View full text Add to dashboard Cite

AimsTo analyze intensive slow mannitol poststenting on attenuating stenting‐related early adverse effects in cerebral venous sinus stenosis (CVSS).MethodsThis real‐world study enrolled subacute or chronic CVSS patients from January 2017 through March 2022 and divided them into DSA only and stenting post‐DSA groups. The later group was subdivided into control (without extra mannitol use) and intensive slow mannitol subgroup (immediate extra mannitol 250–500 mL, 2 mL/min infusion post‐stenting) after signed informed consent. All data were compared.ResultsA total of 95 eligible patients entered into final analysis, in which 37 cases underwent DSA only and 58 cases underwent stenting post‐DSA. Finally, 28 patients were entered into intensive slow mannitol subgroup and 30 in control. Stenting group vs. DSA group, HIT‐6 scores and WBC counts were higher in the former (both p < 0.001). Intensive slow mannitol subgroup vs. control on the third day post‐stenting, a statistically significant reductions were noticed in the former on WBC counts (6.19 ± 1.86 × 109/L vs. 9.59 ± 2.05 × 109/L); HIT‐6 scores (degree of headache) (40.00 (38.00–40.00) vs. 49.00 (41.75–55.25)) and brain edema surrounding the stent on CT maps (17.86% vs.96.67%), all p < 0.001.ConclusionsStenting‐related severe headache, inflammatory biomarkers elevation, and brain edema aggravation can be attenuated by intensive slow mannitol infusion.

show abstract

Section: Headache and Intracranial Hemorrhage Post-stentingmentioning

confidence: 42%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Intensive mannitol slow infusion post‐stenting may attenuate stenting‐related early adverse effects in patients with cerebral venous sinus stenosis

et al. 2023

Self Cite

View full text Add to dashboard Cite

show abstract

“…It is important to prescreen for bony compression in IJVS before stenting, as the high proportion of bony compressions in IJVS (around 40%) may prevent stent inflation 5,8,20 . In addition, early identification and management of rare major complications, such as acute subdural hematoma, cerebellar hemorrhage, acute obstructive hydrocephalus, and subarachnoid hemorrhage, are crucial to achieving a favorable clinical outcome 22,34 . However, the pathophysiology behind these complications is not fully understood, and several studies have discussed their characteristics and potential consequences for surgery and medication 22,29,34 .…”

Section: Discussionmentioning

confidence: 99%

Long‐term safety and efficacy of stenting on correcting internal jugular vein and cerebral venous sinus stenosis

Bai

Chen

Ding

et al. 2023

Ann Clin Transl Neurol

Self Cite

View full text Add to dashboard Cite

ObjectivesTo compare the long‐term safety and efficacy of stenting in correcting cerebral venous sinus stenosis (CVSS) and internal jugular venous stenosis (IJVS).MethodsPatients confirmed with CVSS or IJVS by imaging were enrolled in this real‐world study from 2014 through 2021. Clinical characteristics and long‐term outcomes of these two diseases entities post‐stenting were followed up and compared.ResultsThree hundred and nineteen patients were enrolled in this study, with a mean age of 48.83 years and a BMI of 25.08 on average. In which, 144 patients underwent stenting, the stenotic segments were corrected and the venous blood flow was restored immediately post‐stenting. At 6.15 ± 1.67 days follow‐up, significant improvement was observed in headache, tinnitus, insomnia, ICP, and mean pressure gradient in both groups (all p < 0.05). At 30.53 ± 4.41 months follow‐up post‐stenting, the headache, tinnitus, visual loss, papilledema, and insomnia were attenuated remarkably or even completely disappeared. The Frisen papilledema grade scores declined from 2 (0–4) to 1 (0–3) in IJVS group and from 4 (1–5) to 1 (0–4) in CVSS group compared to the baseline. One hundred and twenty‐seven out of the 144 patients (95.5%) maintained sufficient blood flow verified by followed up computed tomographic venography or contrast‐enhanced magnetic resonance angiography. Adverse events related to stenting included three cases of intraluminal restenosis and three cases of in‐stent thrombosis, no intracranial hemorrhage, venous thromboembolisms, stent‐adjacent stenosis, and stent displacement occurred.InterpretationUsing stents to correct IH and related neurological issues has shown to be a safe and effective approach for both IJVS and CVSS.

show abstract

“…Our results are consistent with other studies that demonstrated that stenting is an effective method for CVSS-induced severe intracranial hypertension correction [ 9 , 18 ]. Although the MPG decreased poststenting, cerebral venous blood flow was restored, and the ICP was corrected immediately poststent management, which is still important for long-term favorable outcomes, and adequate treatment strategies are urgently needed [ 11 , 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

Safety and efficacy comparison between OACs plus single antiplatelet and dual antiplatelet therapy in patients with cerebral venous sinus stenosis poststenting

Bai

Chen

et al. 2022

BMC Neurol

Self Cite

View full text Add to dashboard Cite

Background and purpose The present strategies regarding poststent management for cerebral venous sinus stenosis (CVSS) are inconsistent. Herein, we compared the safety and efficacy of oral anticoagulants (OACs) plus single antiplatelet therapy and dual antiplatelet therapy for CVSS poststenting. Methods A real-world observational study conducted from January 2009 through October 2019 enrolled patients who were diagnosed with CVSS and received stenting. Patients were divided into two groups according to the management they received poststenting. Group 1: OACs plus a single antiplatelet agent (clopidogrel 75 mg or aspirin 100 mg) and Group 2: dual antiplatelet therapy (clopidogrel 75 mg plus aspirin 100 mg). The safety (such as major or minor bleeding or venous thrombosis) and efficacy (the incidences of cerebral venous sinus restenosis, intrastent thrombosis, or stent displacement) of the two groups were compared. Results There were a total of 110 eligible patients in the final analysis, including 79 females and 31 males with a mean age of 43.42 ± 13.23 years. No major bleeding or venous thrombosis occurred in either of the two groups. Two minor bleeding events occurred in group 2 (one with subcutaneous bleeding points in both lower limbs, another with submucosal bleeding in the mouth), whereas no bleeding events occurred in Group 1. In addition, at the 1-year follow-up, one case of intraluminal restenosis and two cases of in-stent thrombi occurred in Group 2, while none occurred in Group 1. Neither stenosis at stent-adjacent segments nor stent migration was detected in either group during the 1-year following stent placement. Conclusion OACs plus single antiplatelet therapy and dual antiplatelet therapy alone are both safe and efficacious management strategies after CVSS stent placement. The former may have more advantages than the latter for inhibiting intrastent thrombosis. However, further research by larger, multicenter clinical trials is needed.

show abstract

Perioperative mannitol intensive use may avoid the early complication of cerebral venous sinus stenting

Cited by 3 publications

References 22 publications

Intensive mannitol slow infusion post‐stenting may attenuate stenting‐related early adverse effects in patients with cerebral venous sinus stenosis

Intensive mannitol slow infusion post‐stenting may attenuate stenting‐related early adverse effects in patients with cerebral venous sinus stenosis

Long‐term safety and efficacy of stenting on correcting internal jugular vein and cerebral venous sinus stenosis

Safety and efficacy comparison between OACs plus single antiplatelet and dual antiplatelet therapy in patients with cerebral venous sinus stenosis poststenting

Contact Info

Product

Resources

About